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Sedation scales

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Ramsay sedation scale

Score Response
1 Anxious or restless or both
2 Cooperative, orientated and tranquil
3 Responding to commands
4 Brisk response to stimulus
5 Sluggish response to stimulus
6 No response to stimulus

Motor activity assessment scale

Score Level of sedation Response to stimulation Response to command Examples of type of complex motor activity
6 Dangerously agitated and uncooperative.  No external stimulus required to elicit movement. Does not calm down when asked. Patient pulling at tubes or catheters or thrashing from side to side or striking at staff or trying to climb out of bed. 
5 Agitated. No external stimulus required to elicit movement. Does not consistently obey commands (eg will lie down when asked but soon reverts to attempts to sit up) Patient attempts to sit up and moves limbs out of bed.
4 Restless but cooperative No external stimulus required to elicit movement. Obeys commands. Patient is picking at sheets or tubes or uncovering self.
3 Calm and cooperative No external stimulus required to elicit movement. Obeys commands. Patient adjusts sheets or clothes purposefully.
2 Responsive to touch or name Opens eyes or raises eyebrows or turns head toward stimulus or moves limbs when touched or name is loudly spoken.    
1 Responsive only to noxious stimuli Opens eyes or raises eyebrows or turns head toward stimulus or moves limbs in response to noxious stimulus (tracheal suctioning or 5 secs of vigorous orbital, sternal or nailbed pressure)    
0 Unresponsive Does not move with noxious stimulus    

Sedation-agitation scale

Score Level of sedation-agitation Response
7 Dangerous agitation Pulling at endotracheal tube, thrashing, climbing over bed rails
6 Very agitated Does not calm, requires restraints, bites endotracheal tube
5 Agitated Attempts to sit up but calms to verbal instructions
4 Calm and cooperative Obeys commands
3 Sedated Difficult to rouse, obeyss simple commands
2 Very sedated Rouses to stimuli. Does not obey commands
1 Unarousable Minimal or no response to noxious stimuli

Further reading

Liu LL, Gropper MA. Postoperative analgesia and sedation in the adult intensive care unit. A guide to drug selection. Drugs, 2003; 63(8):755-67


©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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